Causes of Death in Nineteenth-Century New England: The Dominance of Infectious Disease

"Using the concept of the epidemiologic transition, this paper examines the long-term changes in morbidity and mortality in Germany during the nineteenth and twentieth century. It focuses on the duration of the transitional phases and their main characteristics by investigating age specific mortality rates and causes-of-death. Applying epidemiological methods such as mean age of death and potential years of life lost will contribute to understand better the epidemiologic transition and its causes from the late nineteenth century onwards. These methods have so far hardly been applied in historical research. They will be related to the causes of death which have been grouped together in 15 categories." (EXCERPT)

Plasma human immunodeficiency virus type 1 (HIV-1) viral load and CD4+ cell count are used to predict prognosis of persons infected with HIV. However, whether combining these markers improves prognostic accuracy and whether they predict prognosis for injection drug users (IDUs) and nonwhite persons infected with HIV has not been extensively investigated. To evaluate plasma viral load and CD4+ cell count as prognostic indicators for the acquired immunodeficiency syndrome (AIDS) and infectious disease deaths. Cohort study initiated in 1988 and 1989 with follow-up for up to 7.9 years. Injection drug users infected with HIV recruited from the community in Baltimore, Md. Plasma HIV-1 RNA and CD4+ cell count measured at baseline compared with time to first clinical AIDS diagnosis and death due to an infectious disease. Of 522 subjects, 96% were African American, 80% were male, 96% injected drugs within the past 6 months, and the median age was 33 years. A total of 146 cases of AIDS and 119 infectious disease deaths were seen during a median follow-up period of 6.4 years. Time-fixed baseline levels of viral load and CD4+ cell count were independent predictors of progression to AIDS and infectious disease deaths, but in proportional hazards models, viral load had better predictive value than CD4+ cell count. Kaplan-Meier analysis of time to AIDS and to infectious disease deaths by viral load (<500, 500-9999, 10000-29 999, > or =30000 copies/mL) at 3 levels of CD4+ cell count (<0.20, 0.20-0.49, and > or =0.50x10(9)/L [<200,200-499, and > or =500/microL]) was reduced to a 5-stage classification scheme using a backward stepwise regression procedure. The 5-year cumulative probabilities for AIDS and infectious disease deaths ranged from 0% and 0%, respectively, for group I (viral load, <500 copies/mL; CD4+ cell count, 0.50x10(9)/L) to 81.2% and 76.1% respectively, for group V (viral load, > or =10000 copies/mL; CD4+ cell count, 0.20x10(9)/L). In this study, plasma HIV-1 viral load independently and in combination with CD4+ cell count measurements provided powerful prognostic information for progression to AIDS and death caused by infectious disease in a population of predominantly African American IDUs. Combining categories of both markers provided a simple method for prognostically staging HIV disease.

Alison Bashford and Claire Hooker (eds), Contagion: historical and cultural studies, Routledge Studies in the Social History of Medicine, London and New York, Routledge, 2001, pp. xiii, 240, illus., £55.00 (hardback 0-415-24671-7). - Volume 49 Issue 1

BackgroundRoutinely collected population-wide health data are often used to understand mortality trends including child mortality, as these data are often available more readily or quickly and for lower geographic levels than population-wide mortality data. However, understanding the completeness and accuracy of routine health data sources is essential for their appropriate interpretation and use. This study aims to assess the accuracy of diagnostic coding for public sector in-facility childhood (age < 5 years) infectious disease deaths (lower respiratory tract infections [LRTI], diarrhoea, meningitis, and tuberculous meningitis [TBM]) in routine hospital information systems (RHIS) through comparison with causes of death identified in a child death audit system (Child Healthcare Problem Identification Programme [Child PIP]) and the vital registration system (Death Notification [DN] Surveillance) in the Western Cape, South Africa and to calculate admission mortality rates (number of deaths in admitted patients per 1000 live births) using the best available data from all sources.MethodsThe three data sources: RHIS, Child PIP, and DN Surveillance are integrated and linked by the Western Cape Provincial Health Data Centre using a unique patient identifier. We calculated the deduplicated total number of infectious disease deaths and estimated admission mortality rates using all three data sources. We determined the completeness of Child PIP and DN Surveillance in identifying deaths recorded in RHIS and the level of agreement for causes of death between data sources.ResultsCompleteness of recorded in-facility infectious disease deaths in Child PIP (23/05/2007–08/02/2021) and DN Surveillance (2010–2013) was 70% and 69% respectively. The greatest agreement in infectious causes of death were for diarrhoea and LRTI: 92% and 84% respectively between RHIS and Child PIP, and 98% and 83% respectively between RHIS and DN Surveillance. In-facility infectious disease admission mortality rates decreased significantly for the province: 1.60 (95% CI: 1.37–1.85) to 0.73 (95% CI: 0.56–0.93) deaths per 1000 live births from 2007 to 2020.ConclusionRHIS had accurate causes of death amongst children dying from infectious diseases, particularly for diarrhoea and LRTI, with declining in-facility admission mortality rates over time. We recommend integrating data sources to ensure the most accurate assessment of child deaths.

This article examines how the epidemiologic transition and the reduction of the urban mortality penalty gave rise to the current mortality regime of the United States and demonstrates how the 1918 influenza pandemic signaled its advent. This article approaches those issues through the analysis of urban-rural mortality differentials from 1890 to 1930. Until 1910, infectious diseases dwarfed degenerative diseases in leading causes of death, and generally, the more urban the location was, the higher infectious disease and overall death rates were—a direct relationship. But by 1930, degenerative diseases had eclipsed infectious diseases, and infectious disease mortality had ceased to differ between cities and rural areas. The 1918 influenza pandemic broke out toward the end of these changes, and the larger the city was, the lower influenza and overall death rates were in that year—an inverse relationship. Such gradations characterized a new mortality regime emerging in the late 1910s and foreshadowed urban-rural mortality differentials in 1930 among persons aged 45 years or older, the group whose high rates of degenerative disease death would symbolize that regime. Thus, intertwined changes in the late 19th and early 20th centuries—a shift in leading causes of death from infectious diseases to degenerative diseases and a concomitant shift from a direct relationship to an inverse relationship between urban environment and mortality—produced the current mortality regime of the United States.

This volume presents findings of a World Bank review of the existing and potential role of private voluntary health insurance in low- and middle-income countries and is the third volume in a series of reviews of health care financing. Also, this volume is about managing risk. Not the risk of national or man-made disasters but the risk of illness. The developing world is plagued by many of the historical scourges of poverty: infectious disease, disability, and premature death. As countries pass through demographic and epidemiological transition, they face a new wave of health challenges from chronic diseases and accidents. In this respect, illness has both a predictable and an unpredictable dimension. Contributors to this volume emphasize that the public sector has an important role to play in the health sector, but they demonstrate that the private sector also plays a role in a context in which private spending and delivery of health services often composes 80 percent of total health expenditure. Managing risks in the private sector begins at the household level. Private voluntary health insurance is merely an extension of such nongovernmental ways to deal with the risk of illness and its impoverishing effects in low- and middle-income countries. The authors examine frameworks for analyzing health financing and health insurance. They conclude that most studies are hampered by lack of data on the impact of private voluntary health insurance on broad social goals, such as financial protection. They find no overall consensus on the impact of voluntary health insurance on public health activities or on the quality, innovation, and efficiency of personal health services.

Increasing infectious disease deaths, the emergence of new infections, and bioterrorism have made surveillance for infectious diseases a public health concern. Medical examiners and coroners certify approximately 20% of all deaths that occur within the United States and can be a key source of information regarding infectious disease deaths. We hypothesized that a computer-assisted search tool (algorithm) could detect infectious disease deaths from a medical examiner database, thereby reducing the time and resources required to perform such surveillance manually. We developed two algorithms, applied them to a medical examiner database, and verified the cases identified against the opinion of a panel of experts. The algorithms detected deaths with infectious components with sensitivities from 67% to 94%, and predictive value positives ranging from 8% to 49%. Algorithms can be useful for surveillance in medical examiner offices that have limited resources or for conducting surveillance across medical examiner jurisdictions.

“Med-X”: a medical examiner surveillance model for bioterrorism and infectious disease mortality

David ARNOLD: Introduction: Tropical Medicine before Manson. M.N. PEARSON: First Contacts between Indian and European Medical Systems: Goa in the Sixteenth Century. Peter BOOMGAARD: Dutch Medicine in Asia, 1600-1900. Kenneth F. KIPLE and Kriemhild CONEE ORNELAS: Race, War and Tropical Medicine in the Eighteenth-Century Caribbean. Michael A. OSBORNE: Resurrecting Hippocrates: Hygienic Sciences and the French Scientific Expeditions to Egypt, Morea and Algeria. Philip D. CURTIN: Disease and Imperialism. Julyan G. PEARD: Tropical Medicine in Nineteenth-Century Brazil: The Case of the 'Escola Tropicalista Bahiana', 1860-1890. Mark HARRISON: A Question of Locality: The Identity of Cholera in British India, 1860-1890. Anne Marie MOULIN: Tropical without the Tropics: The Turning-Point of Pastorian Medicine in North Africa. Michael WORBOYS: Germs, Malaria and the Invention of Mansonian Tropical Medicine: From 'Diseases in the Tropics' to 'Tropical Diseases'. Douglas Melvin HAYNES: Social Status and Imperial Service: Tropical Medicine and the British Medical Profession in the Nineteenth Century. Index.

ObjectivesTo analyze data collected through the National Infectious Disease Surveillance System to provide information on infectious disease outbreaks and deaths for use in infectious disease prevention and management.MethodsOn June 26, 2025, the status of infectious disease outbreaks and deaths reported in 2024 was analyzed and announced, based on the reporting scope and criteria for each statutory infectious disease.ResultsIn 2024, 40 of 66 infectious diseases under surveillance were reported, whereas 26 remained unreported. The number of reported infectious diseases under surveillance is 171,376, a significant decrease from 5,626,627 in 2023. However, excluding coronavirus disease 2019 (COVID-19) and syphilis, which had fluctuations in infectious disease levels between 2023 and 2024, the number increased by 54.5% from 109,087 in 2023 to 168,586 in 2024. The major infectious diseases that showed an increase were pertussis, scarlet fever, chickenpox, and Carbapenem-resistant Enterobacterales (CRE) infections, and those that decreased were mumps, tuberculosis, hepatitis C, and hepatitis A. Reported imported infectious diseases in 2024 totaled 606, including dengue fever, primary syphilis, malaria, chickenpox, and hepatitis C. The number of deaths reported in 2024 was 1,238, excluding tuberculosis, which is an 18.2% increase compared to that of 2023, when excluding COVID-19 deaths 2023; with the major infectious diseases being CRE, acquired immunodeficiency syndrome, and pneumococcal infection.ConclusionsThe statutory infectious disease surveillance system can be used to produce basic data and develop policies for infectious disease prevention and management.

Recent genetic and biomedical research has opened up new perspectives on the origins of human malarial infections in an era before the Neolithic agricultural revolution circa 12–10 ka. This chapter summarizes recent findings on the origins of the two most important human malaria parasites, Plasmodium vivax and Plasmodium falciparum , and it discusses evidence that bears on our understanding of the dispersal of these parasites within Africa and beyond to Eurasia. It argues that evidence from a number of different disciplines, including genetics, archaeology, and historical linguistics, is consilient with a new interpretation of the first epidemiological transition in human history. Keywords : Malaria, epidemiological transition, parasite dispersal, Plasmodium vivax, Plasmodium falciparum Recent genetic and biomedical research has opened up new perspectives on the origins of human malarial infections in an era before the Neolithic agricultural revolution circa 12–10 ka. This chapter summarizes recent findings on the origins of the two most important human malaria parasites, Plasmodium vivax and Plasmodium falciparum , and it discusses evidence that bears on our understanding of the dispersal of these parasites within Africa and beyond to Eurasia. It argues that evidence from a number of different disciplines, including genetics, archaeology, and historical linguistics, is consilient with a new interpretation of the first epidemiological transition in human history. THE GLOBAL EXPANSION OF MALARIA PARASITES Malaria parasites are among the oldest of the pathogens that afflict human beings. Over deep time, as elements of a large assemblage of biota that traveled with human migrants (Boivin, this volume), the malaria parasites achieved an enormous expansion of range (see also Green, this volume). From a rainforest hearth in tropical Africa, the parasites spread beyond tropical Africa to Eurasia and, following the European voyages of discovery, to the Americas and Australia. The parasites reached their maximal spatial extension in the late nineteenth and early twentieth centuries. From the 1930s onward, the use of effective antimalarial drugs to protect against malarial infections, large-scale environmental engineering to reduce mosquito habitat, and insecticides to reduce mosquito density reduced the global malaria zone (Figure 18.1) (Webb 2009). Ongoing efforts at malaria control and elimination in the early twenty-first century continue to shrink the “malaria map,” yet approximately 3.3 billion people, or about 45 percent of world population, are still at risk for malarial infections, and hundreds of millions annually are infected. An estimated 650,000 to 1.3 million people die each year from malaria.

Background: The causes of death have changed with regard to the epidemiological and demographic events in society. There is no evidence of prior research into the epidemiological transition in Turkey. This transition in Turkey should be observed starting with the Ottoman Empire period (19th to early 20th century). However, information about the Ottoman Empire is quite limited.Aims: To discuss the epidemiological and demographic transitions in Turkey, using demographic, educational and urbanization data in our present study.Study Design: A descriptive archive study.Methods: Mortality statistics dating from 1931 and published by the Turkish Statistical Institute were analysed, and the causes of death were coded and classified according to ICD-10. Other data were obtained from the published reports and studies regarding the issue.Results: In the 1930s, Turkey’s life expectancy was low (aged 40 years), fertility and mortality rates were high (respectively 45% and 31%), and the main causes of death were infectious diseases. Nowadays, life expectancy is close to 80 years, the total fertility rate has dropped to 2.1 per woman, and the main causes of death are chronic diseases and cancer. The population rate in the urban areas has increased steadily from 24.2% in 1927 to 77.3% in 2012. level of education has also increased during this period. In 1935, less than 10% of women were literate, and in 2013 90% were literate. Qualitative and quantitative increase have been observed in the presentation and access of healthcare services compared to the early years of the Republic.Conclusion: Turkey has been undergoing a modernization period in the last 200 years, and it is believed that the epidemiological and demographic transitions result from this period. This process has led to urbanization and an increase in the level of education, as well as a decrease in premature deaths, lower fertility rates, and an increase in the elderly population and chronic diseases. It is therefore our conclusion that Turkey needs policies regarding the elderly population and the management of chronic diseases.

Background Global mortality transitions are driven by the epidemiologic transition, resulting in a rise in non-communicable diseases (NCDs), which are partly shaped by the nutrition transition and associated chronic conditions. In low- and middle-income countries, these shifts are often viewed as primarily urban phenomena. Rural populations may therefore be overlooked in efforts to prevent and manage NCDs, despite facing critical public health challenges. Objective This study examines changing patterns of adult mortality and causes of death in rural Senegal to illustrate ongoing mortality, epidemiologic, and nutrition transitions. Methods Using data from three rural sites in the Senegalese Health and Demographic Surveillance System, we analysed adult mortality from 1985 to 2020. We calculated all-cause and cause-specific mortality rates among individuals aged 15 to 70 years, based on causes of death determined through verbal autopsy. Results Mortality declined across all age groups. Deaths from communicable diseases, maternal conditions, and undernutrition decreased substantially. NCDs have surpassed communicable diseases as the leading cause of death. Causes of death associated with undernutrition have declined, while diet-related NCDs have increased. Conclusions Adult mortality is declining in the three rural Senegalese sites studied, due to a decline in epidemics. However, NCDs now pose a major rural health threat, consistent with epidemiologic transition theory. The reversal between mortality patterns associated with undernutrition and diet-related NCDs may signal an ongoing nutrition transition. Strong health systems are crucial for both preventing and treating NCDs, and robust health information systems are needed to support deeper analysis of this issue.

Introduction. It is an axiom that demographic processes were and are an urgent problem, since, despite the political and socio-economic development, the countries of the world remain in the process of continuous qualitative restoration and change of human generations, which has a direct impact on the state of labor, educational and defense resources and population health in both spatial and temporal certainty. As a result, the analysis of the essence of the concept of "epidemiological transition" (Аbdel Omran, 1971) and the outline of its role in the practical solution of the problems of regulation of natural movement and quantitative reproduction of the population make this research relevant in its own content.. The aim of the study. To analyze the components of the concept of "epidemiological transition" (Аbdel Rahim Omran, 1971) and its role in the study of problems regarding the regulation of natural movement and quantitative reproduction of the population. Materials and methods. Epidemiological, single-moment, continuous, retrospective scientific research of the available and accessible array of scientific and informational literary sources was carried out, in relation to the outlined topic of the scientific work, where methods were used: retrospective, comparison, generalization and abstract methods of research, as well as deductive awareness, structural and logical analysis taking into account the principles of systematicity. Results. It was established that the concept of "epidemiological transition" (Abdel Omran, 1971), without undermining the significance of other theories of "demographic revolutions" worked out before that, directly outlined the scientific direction for solving the problem of natural movement and quantitative reproduction of the population. It is proved that the significance of the analyzed scientific innovation of Abdel Omran lies in the statement about a radical change in the structure of mortality due to the reasons when the predominance of exogenous causes of death (infectious diseases) was replaced by the primacy of endogenous and quasi-endogenous (non-epidemic diseases), which, testified to the epidemiological transition in the state of morbidity and mortality, when non-infectious pathology appeared to be the main cause in solving the problems of natural movement and quantitative reproduction of the population. It is argued that according to the established exogenous and endogenous nature of the causes of Abdel Omran mortality, both stages, models, and factors/determinants on which society or individual citizens have a direct influence in preventing the occurrence of non-communicable diseases are outlined. It is substantiated that only after 30 years the world medical community was able to recommend the scientific achievements of Abdel Omran for practical implementation in health care at the WHO level, which has become a "cornerstone" today in the development of motives for the prevention of non-infectious diseases. Conclusion. The concept of "epidemiological transition" (Abdel Omran, 1971) scientifically convincingly points to a direct path for the societies of the world in solving the problem of natural movement and quantitative reproduction of the population, where the main role in the state of morbidity and mortality is played by endogenous and quasi-endogenous determinants, which, in fact, form group of non-infectious pathology among the population. For democratic Ukraine, this is of urgent importance, since non-communicable diseases are dominant in morbidity and mortality among European countries, which requires uncompromising implementation of the measures of the WHO General Action Plan on "Prevention and control of non-communicable diseases for the period up to 2030".

We would like to thank Graham Mooney and Andrew Noymer and Beth Jarosz for their responses to our ‘Second Opinion’ on ‘Infectious Disease and the Epidemiological Transition in Victorian Britain’.1 Mooney offers a robust attack on our general claim that the importance of infectious diseases as a cause of death in the nineteenth century has been overstated, while seeming to accept what we say about epidemics, while Noymer and Jarosz take us to task on what counts as an infectious disease and also provide a critique of the specific limitations of our claims when applied to New England. We are pleased that our piece generated such reactions and hope that the debate will continue.